Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network.
If I take ashwagandha, should we check my liver enzymes before I start and again after a couple of months, and what symptoms should make me stop and call you?
Suggestive but preliminary. Not settled. how we score evidence
Ashwagandha is sold in the US as a dietary supplement under the Dietary Supplement Health and Education Act of 1994 (DSHEA).
Five patients (mean age 43) developed jaundice with nausea, lethargy, itching, and abdominal discomfort 2 to 12 weeks after starting ashwagandha-containing supplements; the injury was cholestatic or mixed, itching and high bilirubin persisted for 5 to 20 weeks, and chemical analysis confirmed ashwagandha in the products with no other toxic compounds identified. No one developed liver failure and liver tests normalised within 1 to 5 months in the four patients followed up. Five cases cannot tell you how often this happens, but they establish that it happens.
Worth asking
If I take ashwagandha, should we check my liver enzymes before I start and again after a couple of months, and what symptoms should make me stop and call you?
Source
Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. — Björnsson HK, Björnsson ES, Avula B, et al. (2020)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1111/liv.14393
DOI: 10.1111/liv.14393
How this was scored
- Study design
- Case series or case report
- Funding
- Independently funded
- Published in
- Reputable peer-reviewed journal
- Sample size
- 5
- Preregistered
- No
- Conflicts disclosed
- Yes
- Independent of proponent
- Yes
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Where we put this study in context
Questions
How strong is the evidence behind this?
Resolv rates this source "early signal". Suggestive but preliminary. Not settled. It scores 53 out of 100 on our published rubric. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. — Björnsson HK, Björnsson ES, Avula B, et al. (2020). Published in: Reputable peer-reviewed journal. DOI: 10.1111/liv.14393. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Case series or case report. Funding: Independently funded. The researchers were independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is ashwagandha, withania somnifera, ksm-66, sensoril, shoden, indian ginseng, winter cherry, ashwagandha root extract FDA approved for this use?
No. Its current status is: Not FDA-evaluated for this use. Ashwagandha is sold in the US as a dietary supplement under the Dietary Supplement Health and Education Act of 1994 (DSHEA).
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.